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      <JournalTitle>African Journal of Health Economics</JournalTitle>
      <Volume-Issue>Volume 7 issue 2</Volume-Issue>
      <Season>December 2018</Season>
      <ArticleType>Review &amp; Research</ArticleType>
      <ArticleTitle>Analysis of Direct Medical Costs of Acute Stroke among Patients in a Tertiary Hospital in Ibadan, South-West, Nigeria</ArticleTitle>
      <Abstract>Background:The medical costs of treating acute stroke represent a major burden for patients, especially in countries where out-of-pocket (OOP) payment is a major source of health care financing. This study used a micro-costing approach to estimate the direct costs of acute episode of stroke among 175 patients admitted between February and May 2015 in a tertiary hospital in Ibadan, Nigeria.&#13;
Methods: A 10% threshold with patients__ampersandsign#39; household annual per capita income was used to ascertain the incidence of catastrophic health expenditure (CHE) among patients. A patient incurred CHE if the OOPs exceeded 10% of the annual per capita income of the households where they live. Bivariate analysis was carried out to evaluate the association between CHE and patient-level clinical characteristics.&#13;
Findings: Male respondents were 118 (67.4%), and the mean age of respondents was 60.9 ---PlusMinusSymbol---13.7 years. A total of 156 (89.1%) respondents paid for their medical services through OOPs, while 19 (10.9%) paid through social health insurance. The average health care expenditure on acute stroke treatment for respondents who made OOPs was ?195,672.20---PlusMinusSymbol---?170,661.30 and ?189,817.40---PlusMinusSymbol---?77,114.00 for those whose OOPs was partly offset by social health insurance. The average annual income of the respondents was ?696,685.70---PlusMinusSymbol---?69.834.80 Expenditure on admission/consultation, and radiological services represent the highest costs contributing to patients__ampersandsign#39; average direct medical cost, ?30,822.90 ($154.89) and ?43,200 ($217.09), respectively. This was followed by expenditure on drugs ?27,088.00 ($136.12). Overall, 29.1% of the respondents experienced CHE, of these, 94.1% used out-of-pocket, and 5.9% had some form of social health insurance. The incidence of CHE was significantly associated with low educational status, length of hospital stay, and co-morbidity.&#13;
Conclusion:Acute stroke patients experienced catastrophic health expenditure largely due to huge drugs and laboratory fees. Increasing financial risk protection for these patients would prevent them from impoverishment as a result of enormous medical costs.</Abstract>
      <Keywords>Acute stroke, Catastrophic health expenditure, cost-of-illness, social health insurance, Ibadan</Keywords>
        <Abstract>https://ajhe.org.in/ubijournal-v1copy/journals/abstract.php?article_id=6283&amp;title=Analysis of Direct Medical Costs of Acute Stroke among Patients in a Tertiary Hospital in Ibadan, South-West, Nigeria</Abstract>
        <References>Strong K, Mathers C, Bonita R. Preventing stroke: saving lives around the world. The Lancet Neurology. 2007;6(2):182-7.&#13;
	Di Carlo A. Human and economic burden of stroke. Br Geriatrics Soc; 2009.&#13;
	Chang K-C, Tseng M-C. Costs of acute care of first-ever ischemic stroke in Taiwan. Stroke. 2003;34(11):e219-e21.&#13;
	Krishnamurthi RV, Moran AE, Forouzanfar MH, Bennett DA, Mensah GA, Lawes CM, et al. The global burden of hemorrhagic stroke: a summary of findings from the GBD 2010 study. Global heart. 2014;9(1):101-6.&#13;
	Mapulanga M, Nzala S, Mweemba C. The Socio?economic Impact of Stroke on Households in Livingstone District, Zambia: A Cross?sectional Study. Annals of medical and health sciences research. 2014;4(8):123-7.&#13;
	Njoku C, Aduloju A. Stroke in Sokoto, Nigeria: A five-year retrospective study. 2004.&#13;
	Wahab KW. The burden of stroke in Nigeria. International journal of stroke. 2008 Nov;3(4):290-2.&#13;
	Ezejimofor MC, Uthman OA, Maduka O, Ezeabasili AC, Onwuchekwa AC, Ezejimofor BC, Asuquo E, Chen YF, Stranges S, Kandala NB. Stroke survivors in Nigeria: A door-to-door prevalence survey from the Niger Delta region. Journal of the neurological sciences. 2017 Jan 15;372:262-9.&#13;
	Desalu OO, Wahab KW, Fawale B, Olarenwaju TO, Busari OA, Adekoya AO, et al. A review of stroke admissions at a tertiary hospital in rural Southwestern Nigeria. Annals of African Medicine. 2011;10(2).&#13;
	Komolafe M, Ogunlade O, Komolafe EO. Stroke mortality in a teaching hospital in South Western Nigeria. Tropical doctor. 2007;37(3):186-8.&#13;
	Wahab K, Okubadejo N, Ojini F, Danesi M. Predictors of short-term intra-hospital case fatality following first-ever acute ischaemic stroke in Nigerians. J Coll Physicians Surg Pak. 2008;18(12):755-8.&#13;
	World Health Organization (2005). Designing health financing systems to reduce catastrophic health expenditure.&#13;
	Wagstaff A, Doorslaer Ev. Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993-1998. Health economics. 2003;12(11):921-33.&#13;
	Van Doorslaer E, Oand;#39;Donnell O, Rannan-Eliya RP, Somanathan A, Adhikari SR, Garg CC, et al. Effect of payments for health care on poverty estimates in 11 countries in Asia: an analysis of household survey data. The Lancet. 2006;368(9544):1357-64.&#13;
	Yoneda Y, Uehara T, Yamasaki H, Kita Y, Tabuchi M, Mori E. Hospital-based study of the care and cost of acute ischemic stroke in Japan. Stroke. 2003;34(3):718-24.&#13;
	Mamoli A, Censori B, Casto L, Sileo C, Cesana B, Camerlingo M. An analysis of the costs of ischemic stroke in an Italian stroke unit. Neurology. 1999;53(1):112.&#13;
	Christensen M, Previgliano I, Capparelli F, Lerman D, Lee W, Wainsztein N. Acute treatment costs of intracerebral hemorrhage and ischemic stroke in Argentina. Acta Neurologica Scandinavica. 2009;119(4):246-53.&#13;
	Tolla MT, Norheim OF, Verguet S, Bekele A, Amenu K, Abdisa SG, Johansson KA. Out-of-pocket expenditures for prevention and treatment of cardiovascular disease in general and specialized cardiac hospitals in Addis Ababa, Ethiopia: a cross-sectional cohort study. BMJ global health. 2017 Jul 1;2(2):e000280.&#13;
	Baker L, Birnbaum H, Geppert J, Mishol D, Moyneur E. The Relationship Between Technology Availability And Health Care Spending: Attempts to address technology availability and rising costs could end up badly misguided if implications for quality are not considered. Health Affairs. 2003;22(Suppl1): W3-537.&#13;
	Caro JJ, Huybrechts KF. Stroke Treatment Economic Model (STEM). Stroke. 1999;30(12):2574-9.&#13;
	Caro JJ, Huybrechts KF, Duchesne I. Management patterns and costs of acute ischemic stroke. Stroke. 2000;31(3):582-90.&#13;
	Taylor, TN, Davis PH, Torner JC, Holmes J, Meyer JW, Jacobson MF. Lifetime cost of stroke in the United States. Stroke. 1996;27(9):1459-66.&#13;
	Pinkhasov RM, Wong J, Kashanian J, Lee M, Samadi DB, Pinkhasov MM, et al. Are men shortchanged on health? Perspective on health care utilization and health risk behavior in men and women in the United States. International journal of clinical practice. 2010;64(4):475-87.&#13;
	Allgand;ouml;wer A, Wardle J, Steptoe A. Depressive symptoms, social support, and personal health behaviors in young men and women. Health Psychology. 2011;20(3):223.&#13;
	Bonita R. Epidemiology of stroke. The Lancet. 1992;339(8789):342-4.&#13;
	McGowan B, Heerey A, Tilson L, Ryan M, Barry M. Cost of treating stroke in an Irish teaching hospital. Irish medical journal. 2003;96(8):234-6</References>